Models, components, and outcomes of palliative and end-of-life care provided to adults living at home: A systematic review of reviews
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Background
Ageing populations necessitate increased focus on home-based care. The best models and components for community-based palliative and end-of-life care are unknown.
Aim
To identify and synthesise review-level evidence on models of palliative and end-of-life care for adults living at home, and examine components of these models and their association with outcomes.
Design
A review of narrative, scoping and systematic reviews, using key concepts established a priori from Firth et al. and Brereton et al.’s model descriptions. Quality assessment used AMSTAR-2 or equivalent.
Data sources
MEDLINE, EMBASE, CINAHL, Cochrane Database, Epistemonikos searched from inception to August 2024, supplemented by CareSearch, PROSPERO, and citation searches.
Results
From 6683 initial papers, n=66 reviews were included. Seven models of care were identified; by setting (in-home, outpatient); type of professionals (specialist, integrated, non-specialist); or mode (telehealth, education/training). Components included: holistic person-centred assessment, skilled professionals, access to medicines/care/equipment, patient/family support, advance care planning, integration of services, virtual/remote technology, and education. We categorised outcomes into: i) patient outcomes, ii) family/informal caregiver outcomes, iii) professional outcomes, and iv) service utilisation/cost outcomes. The ‘in-home palliative care’ model was most researched with good evidence of positive benefit. Specialist and integrated models of care were next most researched, with evidence of improved patient and service utilisation outcomes. Cost-effectiveness evidence was lacking.
Conclusion
This meta-level evidence supports provision of in-home palliative care, with most review level evidence showing positive effect on patient outcomes. There was also evidence to support specialist palliative care and integration of primary palliative care with specialist support.
Key statements
What is already known about the topic?
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Care at home for people approaching the last months or year of life has become increasingly important in recent years, due to the increase in deaths, multimorbidity, and preference of the majority for care at home.
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Individual reviews of the evidence on palliative and end of life care at home have been undertaken, with some evidence of benefit.
What this paper adds
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This paper reports the overall evidence, which largely supports in-home palliative care, especially if delivered via specialist palliative care models or integrated palliative care models (where integration refers to coordination between specialist and non-specialist services).
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It also provides evidence of benefit for education and training, both for informal family carers, and for professionals.
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Detailed narrative synthesis links models of care, with their components and sub-components, and related outcomes.
Implications for practice, theory or policy
There is clear evidence supporting provision of in-home palliative care, with common components related to addressing (and delivering positive impact on) patients’ symptoms, psychological distress, and functional status.
